What is the treatment for a red scalp wound caused by a fungal infection?

Treatment for Red Scalp Wound from Fungal Infection

For a red scalp wound caused by fungal infection, the recommended treatment is oral antifungal therapy, as topical therapy alone is ineffective for tinea capitis. 1

Diagnostic Considerations

• Scalp lesions should be sampled via scalpel scraping, hair pluck, brush, or swab for microscopy and culture to identify the causative organism 1
• Treatment can begin while awaiting confirmatory mycology when clinical signs such as scale, lymphadenopathy, or alopecia are present 1
• The choice of systemic therapy should be directed by the causative dermatophyte and local epidemiology 1

First-Line Treatment Options

For Trichophyton species infections:

• Terbinafine (preferred for Trichophyton species) 1
  • < 20 kg: 62.5 mg per day for 2-4 weeks
  • 20-40 kg: 125 mg per day for 2-4 weeks

  • 40 kg: 250 mg per day for 2-4 weeks

For Microsporum species infections:

• Griseofulvin (preferred for Microsporum species) 1
  • < 50 kg: 15-20 mg/kg per day (single or divided dose) for 6-8 weeks

  • 50 kg: 1 g per day (single or divided dose) for 6-8 weeks

Adjunctive Therapy

• Antifungal shampoo containing selenium sulfide or ketoconazole should be used twice weekly as an adjunct to systemic therapy 1, 2, 3
• Selenium sulfide shampoo: Apply to affected areas, lather with water, leave for 2-3 minutes, then rinse thoroughly 2
• Ketoconazole shampoo: Effective for treating seborrheic dermatitis and fungal infections of the scalp 3

Second-Line Treatment Options

• Itraconazole (effective against both Trichophyton and Microsporum species) 1
  • 5 mg/kg per day for 2-4 weeks
• If initial therapy fails after 2-4 weeks, consider:
  • Extending treatment duration for another 2-4 weeks 1
  • Switching to an alternative agent (terbinafine for Microsporum or griseofulvin for Trichophyton if the alternate was used first-line) 1

Treatment Failure Considerations

• Consider potential causes of treatment failure 1:
  • Lack of compliance
  • Suboptimal absorption of drug
  • Relative insensitivity of the organism
  • Reinfection
• If there is clinical improvement but ongoing positive mycology, continue current therapy for an additional 2-4 weeks 1
• If no clinical improvement is observed, switch to second-line therapy 1

Important Considerations

• Oral therapy is required as topical therapy alone is ineffective for tinea capitis 1, 4
• Duration of treatment varies based on the causative organism - Trichophyton typically requires shorter treatment (2-4 weeks) compared to Microsporum (6-8 weeks) 5
• Treatment should continue until clinical and mycological cure is achieved 1
• Family members should be examined for asymptomatic carriage and treated if necessary to prevent reinfection 1